In 2012, the Centers for Disease Control and Prevention (CDC) launched the national Tips From Former Smokers (Tips) campaign to encourage people who smoke to quit by showing real-life heath consequences of tobacco use and promoting evidence-based resources for quitting. To assess the campaign's impact on quit attempts and sustained-quit estimates (ie, quits lasting ≥6 mos), CDC analyzed data from a nationally representative longitudinal survey of US adults who smoke cigarettes, aged 18 years or older in 2012-2018. The Tips campaign was associated with an estimated 16.4 million quit attempts and 1,005,419 sustained quits. Continued implementation of cessation campaigns, including the Tips campaign, could accelerate progress toward reducing rates of smoking-related diseases and death.

OBJECTIVE: To advance public health support for the U.S. Department of Housing and Urban Development's smoke-free rule, the Centers for Disease Control and Prevention collaborated with the Georgia Institute of Technology to develop a geospatial mapping tool. The objective was to create a tool state and local public health agencies could use to tailor smoke-free educational materials and cessation interventions for specific public housing development resident populations. RESULTS: The resulting "Extinguish Tool" includes an interactive map of U.S. public housing developments (PHDs) and healthcare facilities that provides detailed information on individual PHDs, their proximity to existing healthcare facilities, and the demographic characteristics of residents. The tool also estimates the number of PHD residents who smoke cigarettes and calculates crude estimates of the potential economic benefits of providing cessation interventions to these residents. The geospatial mapping tool project serves as an example of a collaborative and innovative public health approach to protecting the health and well-being of the nation's two million public housing residents, including 760,000 children, from the harms of tobacco smoking and secondhand smoke exposure in the places where they live, play, and gather.

INTRODUCTION: Heated tobacco products, sometimes marketed as "heat-not-burn" technology, represent a diverse class of products that heat leaf tobacco to produce an inhaled aerosol. Global sales of heated tobacco products are increasing; however, the extent of current heated tobacco product awareness and use in the U.S. is unknown. This study assessed awareness and ever use of heated tobacco products among U.S. adults. METHODS: Data were obtained from the 2017 SummerStyles, an Internet survey of U.S. adults aged >/=18 years (N=4,107). Respondents were given a description of heated tobacco products, then asked about awareness and ever use. In 2017, descriptive statistics were calculated overall and by sex, age, race/ethnicity, and cigarette smoking status. Logistic regression was used to calculate AORs. RESULTS: In 2017, a total of 5.2% of U.S. adults were aware of heated tobacco products, including 9.9% of current cigarette smokers. Overall, 0.7% of U.S. adults, including 2.7% of current smokers, reported ever use of heated tobacco products. Odds of ever use were higher among current smokers (AOR=6.18) than never smokers, and higher among adults aged <30 years (AOR=3.35) than those aged >/=30 years. CONCLUSIONS: As of July 2017, few U.S. adults had ever used heated tobacco products; however, about one in 20 were aware of the products, including one in ten cigarette smokers. The uncertain impact of heated tobacco products on individual- and population-level health warrants timely and accurate public health surveillance. These first estimates among U.S. adults can serve as a key baseline measure.

This study provides estimates of the long-term cumulative impact of the Centers for Disease Control and Prevention's national tobacco education campaign, Tips From Former Smokers (Tips), on population-level smoking cessation. We used recently published estimates of the association between increased Tips campaign media doses and quit attempts to calculate campaign-attributable population sustained (6-month) quits during 2012-2015. Tips led to approximately 522,000 sustained quits during 2012-2015. These findings indicate that the Tips campaign's comprehensive approach to combining evidence-based messages with the promotion of cessation resources was successful in achieving substantial long-term cigarette cessation at the population level over multiple years.

Vaccines serve a critical role in the prevention and control of communicable diseases.1 Vaccines have prevented countless cases and saved millions of lives globally from diseases such as polio, smallpox, measles, diphtheria, influenza and multiple others.1 Given the critical importance and past impact of population-based prevention interventions in combating the tobacco epidemic,2,3 we describe a population-based model for reducing tobacco use and secondhand smoke exposure using the public health principles of vaccination.

Despite recent declines in cigarette smoking prevalence, the tobacco product landscape has shifted to include emerging tobacco products* (1,2). Previous research has documented adult use of smokeless tobacco and cigarettes by state (3); however, state-specific data on other tobacco products are limited. To assess tobacco product use in the 50 U.S. states and the District of Columbia (DC), CDC and the National Cancer Institute analyzed self-reported use of six tobacco product types: cigarettes, cigars, regular pipes, water pipes, electronic cigarettes (e-cigarettes), and smokeless tobacco products among adults aged >/=18 years using data from the 2014-2015 Tobacco Use Supplement to the Current Population Survey (TUS-CPS). Prevalence of ever-use of any tobacco product ranged from 27.0% (Utah) to 55.4% (Wyoming). Current (every day or some days) use of any tobacco product ranged from 10.2% (California) to 27.7% (Wyoming). Cigarettes were the most common currently used tobacco product in all states and DC. Among current cigarette smokers, the proportion who currently used one or more other tobacco products ranged from 11.5% (Delaware) to 32.3% (Oregon). Differences in tobacco product use across states underscore the importance of implementing proven population-level strategies to reduce tobacco use and expanding these strategies to cover all forms of tobacco marketed in the United States. Such strategies could include comprehensive smoke-free policies, tobacco product price increases, anti-tobacco mass media campaigns, and barrier-free access to clinical smoking cessation resources (1,4).

In 2015, an estimated 18.8 million U.S. adults were military veterans (1). Although the prevalence of tobacco-attributable conditions is high among veterans (2), there is a paucity of data on use of tobacco products, other than cigarettes, in this population. To monitor tobacco product use among veterans, CDC analyzed self-reported current (i.e., past 30-day) use of five tobacco product types (cigarettes, cigars [big cigars, cigarillos, or little cigars], roll-your-own tobacco, pipes, and smokeless tobacco [chewing tobacco, snuff, dip, or snus]) from the National Survey on Drug Use and Health (NSDUH). Overall, 29.2% of veterans reported current use of any of the assessed tobacco products. Cigarettes were the most commonly used tobacco product (21.6%), followed by cigars (6.2%), smokeless tobacco (5.2%), roll-your-own tobacco (3.0%), and pipes (1.5%); 7.0% of veterans currently used two or more tobacco products. Within subgroups of veterans, current use of any of the assessed tobacco products was higher among persons aged 18-25 years (56.8%), Hispanics (34.0%), persons with less than a high school diploma (37.9%), those with annual family income <$20,000 (44.3%), living in poverty (53.7%), reporting serious psychological distress (48.2%), and with no health insurance (60.1%). By age and sex subgroups, use of any of the assessed tobacco products was significantly higher among all veteran groups than their nonveteran counterparts, except males aged >/=50 years. Expanding the reach of evidence-based tobacco control interventions among veterans could reduce tobacco use prevalence in this population.

An overarching goal of Healthy People 2020 is to achieve health equity, eliminate disparities, and improve health among all groups.* Although significant progress has been made in reducing overall commercial tobacco product use,(dagger) disparities persist, with American Indians or Alaska Natives (AI/ANs) having one of the highest prevalences of cigarette smoking among all racial/ethnic groups (1,2). Variations in cigarette smoking among AI/ANs have been documented by sex and geographic location (3), but not by other sociodemographic characteristics. Furthermore, few data exist on use of tobacco products other than cigarettes among AI/ANs (4). CDC analyzed self-reported current (past 30-day) use of five tobacco product types among AI/AN adults from the 2010-2015 National Survey on Drug Use and Health (NSDUH); results were compared with six other racial/ethnic groups (Hispanic; non-Hispanic white [white]; non-Hispanic black [black]; non-Hispanic Native Hawaiian or other Pacific Islander [NHOPI]; non-Hispanic Asian [Asian]; and non-Hispanic multirace [multirace]). Prevalence of current tobacco product use was significantly higher among AI/ANs than among non-AI/ANs combined for any tobacco product, cigarettes, roll-your-own tobacco, pipes, and smokeless tobacco. Among AI/ANs, prevalence of current use of any tobacco product was higher among males, persons aged 18-25 years, those with less than a high school diploma, those with annual family income <$20,000, those who lived below the federal poverty level, and those who were never married. Addressing the social determinants of health and providing evidence-based, population-level, and culturally appropriate tobacco control interventions could help reduce tobacco product use and eliminate disparities in tobacco product use among AI/ANs.

Nearly six million people worldwide die from tobacco-attributable causes every year, making tobacco the leading cause of preventable disease and death.1 If current trends continue, tobacco use is expected to result in one billion deaths by the end of the century, most of these in low- and middle-income countries.2 Cigarette smoking is the most common form of tobacco use in most countries, and the majority of adult smokers try their first cigarette before the age of 18.3,4 | To reduce the public health threat of tobacco use, the World Health Organization (WHO) has promoted the ratification of the WHO Framework Convention on Tobacco Control (FCTC) and developed demand reduction tools to help countries curb tobacco use (http://www.who.int/fctc/reporting/en/). Specifically, the “MPOWER” package advocates the following evidence-based strategies: Monitor tobacco use and prevention policies; Protect people from tobacco smoke; Offer help to quit tobacco use; Warn about the dangers of tobacco; Enforce bans on tobacco advertising, promotion, and sponsorship; and Raise taxes on tobacco. | The “Monitor” strategy can be used to guide tobacco prevention and control policies. One such policy is limiting access to cigarettes, which is an important way to curb the tobacco epidemic because it prevents smoking initiation among youth.3–5 In 2005, the year the FCTC took effect, 28 of 35 countries in the Americas had not implemented any of the MPOWER strategies.6 By the end of 2015, 6 of 35 countries had implemented at least four of the MPOWER strategies, and 15 of 35 countries had implemented one to three strategies.6 Uruguay, which has a strong track record of tobacco control and has implemented most of the MPOWER strategies, has seen rapid declines in cigarette smoking.7

Tobacco use is the leading cause of preventable disease and death in the United States, and cigarettes are the most commonly used tobacco product among U.S. adults. To assess progress toward achieving the Healthy People 2020 target of reducing the proportion of U.S. adults who smoke cigarettes to ≤12.0% (objective TU1.1), CDC assessed the most recent national estimates of cigarette smoking prevalence among adults aged ≥18 years using data from the 2015 National Health Interview Survey (NHIS). The proportion of U.S. adults who smoke cigarettes declined from 20.9% in 2005 to 15.1% in 2015, and the proportion of daily smokers declined from 16.9% to 11.4%. However, disparities in cigarette smoking persist. In 2015, prevalence of cigarette smoking was higher among adults who were male; were aged 25-44 years; were American Indian/Alaska Native; had a General Education Development certificate (GED); lived below the federal poverty level; lived in the Midwest; were insured through Medicaid or were uninsured; had a disability/limitation; were lesbian, gay, or bisexual; or who had serious psychological distress. Proven population-based interventions, including tobacco price increases, comprehensive smoke-free laws, anti-tobacco mass media campaigns, and barrier-free access to tobacco cessation counseling and medications, are critical to reducing cigarette smoking and smoking-related disease and death among U.S. adults, particularly among subpopulations with the highest smoking prevalences.

Public health policy approaches have demonstrated measurable improvements in population health. Yet, "one-size-fits-all" approaches do not necessarily impact all populations equally and, in some cases, can widen existing disparities. It has been argued that interventions, including policy interventions, can have the greatest impact when they target the social determinants of health. The intent of this article was to describe how selected current policies and policy areas that have a health equity orientation are being used with the aim of reducing health disparities and to illustrate contemporary approaches that can be applied broadly to a variety of program areas to advance health equity. Applying a health equity lens to a Health in All Policies approach is described as a means to develop policies across sectors with the explicit goal of improving health for all while reducing health inequities. Health equity impact assessment is described as a tool that can be effective in prospectively building health equity into policy planning. The discussion suggests that eliminating health inequities will benefit from a deliberate focus on health equity by public health agencies working with other sectors that impact health outcomes.

In 2013, the Institute of Medicine reported persistent gaps between the United States and other high-income countries across multiple risk factors, diseases, and health outcomes. Large gaps also exist within the United States, and life expectancy appears to be declining in some US counties and population groups. These alarming trends cannot be explained by the availability of health care alone; rather, they reflect a complex interplay between the physical and social environment, individual health behaviors, and the health care delivery system. Achieving progress will require population-based interventions that address these factors that contribute to health.

The reports in this supplement document persistent disparities between some population groups in health outcomes, access to health care, adoption of health promoting behaviors, and exposure to health-promoting environments. Some improvements in overall rates and even reductions in some health disparities are noted; however, many gaps persist. These finding highlight the importance of monitoring health status, outcomes, behaviors, and exposures by population groups to assess trends and target interventions. In this report, disparities were found between race and ethnic groups across all of the health topics examined. Differences also were observed by other population characteristics. For example, persons with low socioeconomic status were more likely to be affected by diabetes, hypertension, and human immunodeficiency virus (HIV) infection and were less likely to be screened for colorectal cancer and vaccinated against influenza.

OBJECTIVES: We assessed local health departments' (LHDs') ability to provide data on nonpharmaceutical interventions (NPIs) for the mitigation of 2009 H1N1 influenza during the pandemic response. DESIGN: Local health departments voluntarily participated weekly in a National Association of County and City Health Officials Web-based survey designed to provide situational awareness to federal partners about NPI recommendations and implementation during the response and to provide insight into the epidemiologic context in which recommendations were made. SETTING: Local health departments during the fall 2009 H1N1 pandemic response. PARTICIPANTS: Local health departments that voluntarily participated in the National Association of County and City Health Officials Sentinel Surveillance Network. MAIN OUTCOME MEASURES: Local health departments were asked to report data on recommendations for and the implementation of NPIs from 7 community sectors. Data were also collected on influenza outbreaks; closures, whether recommended by the local health department or not; absenteeism of students in grades K-12; the type(s) of influenza viruses circulating in the jurisdiction; and the health care system capacity. RESULTS: One hundred thirty-nine LHDs participated. Most LHDs issued NPI recommendations to their community over the 10-week survey period with 70% to 97% of LHDs recommending hand hygiene and cough etiquette and 51% to 78% voluntary isolation of ill patients. However, 21% to 48% of LHDs lacked information of closure, absenteeism, or outbreaks in schools, and 28% to 50% lacked information on outpatient clinic capacity. CONCLUSIONS: Many LHDs were unable to monitor implementation of NPI (recommended by LHD or not) within their community during the 2009 H1N1 influenza pandemic. This gap makes it difficult to adjust recommendations or messaging during a public health emergency response. Public health preparedness could be improved by strengthening NPI monitoring capacity.

OBJECTIVE: This report provides an overview and assessment of the School Dismissal Monitoring System (SDMS) that was developed by the Centers for Disease Control and Prevention (CDC) and the US Department of Education (ED) to monitor influenza-like illness (ILI)-related school dismissals during the 2009-2010 school year in the United States. METHODS: SDMS was developed with considerable consultation with CDC's and ED's partners. Further, each state appointed a single school dismissal monitoring contact, even if that state also had its own school-dismissal monitoring system in place. The SDMS received data from three sources: (1) direct reports submitted through CDC's Web site, (2) state monitoring systems, and (3) media scans and online searches. All cases identified through any of the three data sources were verified. RESULTS: Between August 3, 2009, and December 18, 2009, a total of 812 dismissal events (ie, a single school dismissal or dismissal of all schools in a district) were reported in the United States. These dismissal events had an impact on 1947 schools, approximately 623,616 students, and 40,521 teachers. CONCLUSIONS: The SDMS yielded real-time, national summary data that were used widely throughout the US government for situational awareness to assess the impact of CDC guidance and community mitigation efforts and to inform the development of guidance, resources, and tools for schools.